Potential Surgical Targets For Deep Brain Stimulation In Treatment-Resistant Depression

Jason S. Hauptman, MD; Antonio A. F. DeSalles, MD, PhD; Randall Espinoza, MD, MPH; Mark Sedrak, MD; Warren Ishida, MD

Disclosures

Neurosurg Focus. 2008;25(1):E3 

In This Article

Deep Brain Stimulation for MDD

Ablative and irreversible procedures, such as stereotactic limbic leukotomy, anterior capsulotomy, and anterior cingulotomy, have been successfully performed for intractable neuropsychiatric illness, with acceptable results.[10,25,43,48,64] Deep brain stimulation, on the other hand, has the distinct advantage of being reversible, nonablative, and modulatory. It may also be more palatable to patients, who see it as an established treatment for parkinsonism, tremors, and dystonia.[10] Although there have been early reports of successful DBS for MDD,[23,24,32,40,59,64,67,69] critical questions remain. The most appropriate target, optimal stimulation parameters, and long-term effects and efficacy remain uncertain. In response to a published article describing DBS for psychiatric disease, Dr. Cosgrove poignantly wrote that "deep brain stimulation may provide a unique opportunity to help patients who suffer horribly from the consequences of severe depression". early efforts must go forward only with the highest ethical, moral, and scientific standards to ensure that this historic opportunity is not wasted". much is at stake.”[10] This notion is essential.

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